# Cognitive behavioural therapy for insomnia (CBT-I)

Source: https://onco.cc/technologies/cbt-insomnia-cancer/  
OnCo record `cbt-insomnia-cancer` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Insomnia is one of the most persistent problems after cancer treatment. A short structured talking therapy that retrains sleep habits works better and for longer than sleeping tablets, and digital versions bring it to people who cannot reach a therapist.

## Summary

Insomnia affects a large minority of people during and after cancer treatment and rarely resolves on its own. CBT-I combines sleep restriction, stimulus control, cognitive work on sleep-related worry and sleep hygiene over four to eight sessions. A 2016 meta-analysis of randomised trials in cancer survivors found large improvements in insomnia severity, sleep efficiency and sleep-onset latency that held at follow-up; trials of digital CBT-I show similar effects. Sleep guidelines from ASCO (2024), NCCN and the American College of Physicians place CBT-I first line, ahead of hypnotic drugs, which are second line for short-term use. Tai chi was non-inferior to CBT-I in one randomised trial and mindfulness has moderate evidence. Untreated insomnia amplifies fatigue, pain and depression, so screening for it is part of good survivorship care.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-10
- Tags: complementary; supportive-care; evidence:strong
- Principle: Restricting time in bed and decoupling the bed from wakefulness rebuild the homeostatic sleep drive and conditioned sleep cues, while cognitive work reduces the arousal that maintains insomnia.
- Strengths: Large, durable effects in meta-analysis; First line in multiple guidelines; Effective digitally and in groups
- Limitations: Requires effort over several weeks; Trained therapists are scarce; Less studied in advanced disease

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia
- Systematic review and meta-analysis of CBT-I in cancer survivors (Sleep Med Rev 2016): https://doi.org/10.1016/j.smrv.2015.07.001
- Tai chi chih versus CBT-I for insomnia in breast cancer survivors (JCO 2017): https://doi.org/10.1200/JCO.2016.71.0285

## Connected records

- ideas: [Treat insomnia in survivors and measure whether the cancer notices](https://onco.cc/ideas/idea-nl-sleep-circadian-survivorship-rct/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Fatigue after cancer treatment: what actually works](https://onco.cc/technologies/cancer-related-fatigue-management/), [Getting psychological help after cancer: the stepped-care model, and what is actually commissioned](https://onco.cc/technologies/rejuv-mind-access-to-psychological-care/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Sleep after cancer: how common insomnia is, how long it lasts, and the treatment that works](https://onco.cc/technologies/rejuv-mind-sleep-after-cancer/), [Sleep and circadian interventions in cancer](https://onco.cc/technologies/sleep-circadian-interventions/), [Sleeping tablets after cancer: what they do and what they do not](https://onco.cc/technologies/rejuv-mind-sleeping-tablets-after-cancer/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/), [Tai chi and qigong](https://onco.cc/technologies/tai-chi-qigong/), [Thinking and memory after cancer treatment: what is measurable, and what helps](https://onco.cc/technologies/cognitive-impairment-after-cancer-treatment/), [What actually works after treatment](https://onco.cc/technologies/rejuv-frontier-what-works/)
- terms: [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [Quality of life](https://onco.cc/terms/quality-of-life/)
- trials: [Cognitive Behavioral Therapy +/- Armodafinil for Insomnia and Fatigue Following Chemotherapy](https://onco.cc/trials/nct01091974/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors](https://onco.cc/key-papers/paper-johnson-sleep-med-rev/), [Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial](https://onco.cc/key-papers/paper-irwin-j-clin-oncol/)
- roadmaps: [Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it](https://onco.cc/roadmaps/rejuvenation-roadmap/), [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)

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